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Adapting ITIL for Effective Telehealth Service
Management
Session 141, Wednesday, February 13, 2019
Shawn Valenta, Administrator of Telehealth, MUSC Health
Dr. Jillian Harvey, Associate Professor, Medical University of South Carolina
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Shawn Valenta, RRT, MHA
Has no real or apparent conflicts of interest to report.
Jillian Harvey, Ph.D
Has no real or apparent conflicts of interest to report.
Conflict of Interest
3
Agenda
Telehealth Background
Complexities of telehealth service
development, implementation, and
sustainability
Ideas for telehealth best practices:
The structured framework
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Learning Objectives
Recognize the complex factors that challenge effective
telehealth service development, implementation and
sustainability
Describe the five phases of MUSC’s telehealth service
management framework
Identify key elements that contribute to a successful,
sustainable telehealth service
Explain how the RACI Matrix is applied to telehealth
service management
Brief History of Telehealth
Virtual Health: Aligning Solutions With Enterprise-Wide
Priorities. SG2 Intelligence 2014.
6
Background
Obtaining timely healthcare services can be extremely challenging
for patients who reside in rural or medically underserved
communities.
1-2
Telehealth appeal
Improve access
Improve quality
Reduce cost
7
Yet, telemedicine programs not widespread
3-5
Small scale services poorly integrated into health
systems
3, 6
Large-scale IT projects have failure rates >30%
7
75% of successful telehealth pilots not
sustained
8-9
Concerns
8
Telehealth Implementation
Challenges
Resource
Intensive
Assessment &
Evaluation
Insufficient
Planning & Best
Practices
Increasing
Demand
4, 7, 10, 15
9
“Organizationally, telemedicine provides challenges to the
traditional notions of regionalized health care systems”
(Bashshur, 2007)
Persistent problems have not been successfully
addressed:
4, 16
Relationships between traditionally competing delivery
systems
culture, practices, business models, governance
Telehealth organizational structure
Operational system
Boundaries of planning regions
Telehealth Complexity
10
Telehealth Evidence Base
Strength of Evidence
Program Strategy &
Implementation
Outcomes for
Certain Specialties
Delivery & Payment
Models
Cost Effectiveness
Policy
Home Monitoring
Psychotherapy
Support
Access
Patient Satisfaction
Provider Technical
Satisfaction
11-14
Strength of Evidence
Improved
Efficiency
Process
Measures
Travel Costs
Wait Times
Transportation
11
Current telehealth literature includes
multiple & separate frameworks related to:
4, 9
Readiness
Assessment
Implementation
Diffusion
Evaluation
12
Factors that Impact Telehealth Success
(Liezl van Dyk, 2014)
Technology
Organizational Structures
Change Management
Economic feasibility
Societal impacts
Perceptions
User-friendliness
Evaluation and
Evidence
Legislation
Policy and governance
“A holistic implementation approach is needed”
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Analysis:
1. “Strategy…not clearly articulated”; priorities and scope not maintained
2. Services created from different practice areas resulted in variation,
creating further challenges in providing operational support across the
enterprise
3. Numerous stakeholders and competing priorities negatively impacted
service development
4. Fragmented technology; no clear operational procedures
Sustainable Telemedicine: Designing and
Building Infrastructure to Support a
Comprehensive Telemedicine Practice
(Mayo Clinic Experience)
Beth L.H. Kreofsky, R. Nicole Blegen, Troy G. Lokken, Susan M. Kapraun, Matthew
S. Bushman, and Bart M. Demaerschalk.Telemedicine and e-Health.Dec
2018.ahead of printhttp://doi.org/10.1089/tmj.2017.0291
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13+ years of telehealth
experience
> 70 unique telehealth services
A HRSA-designated National
Telehealth Center of
Excellence
Coordinating entity of the
South Carolina Telehealth
Alliance (SCTA)
MUSC Center for Telehealth
Executive Medical Director: Dr. Jimmy McElligott
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Over 200 Connected Sites
(>90% are non-MUSC)
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Volume of MUSC Telehealth
Interactions
0
50000
100000
150000
200000
250000
300000
350000
2014 2015 2016 2017 2018
17
2005
Maternal Fetal
Telemedicine
2008
Telestroke
2009
ICU
Telepsych
2013
State
telehealth
funding
infused by SC
Legislature
2014-Present
MUSC Center for
Telehealth
charged with
accelerated
growth of
telehealth services
Evolution of MUSC’s Telehealth
Services
Created a lot of pieces to service
development (e.g. checklists)
Experienced many growing pains
Concentration risk”
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Initial MUSC Telehealth Goal
“Everything we do within our walls, we should do outside our walls”
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Case Study 1: Inpatient Pediatric GI
Single provider
‘Customized’ workflow
Not consistent across comparable
services
Not mapped out
Confusion re: roles/responsibilities
Poor communication with partner
sites
Inadequate training at partner sites
No formalized evaluation plan
Low utilization
Low satisfaction
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Case Study 2: Outpatient
Transplant Nephrology
Lack of provider champion engagement
Workflow
Everything to everybody = multiple changes to
workflow
Not formally mapped out
Confusion re: roles/responsibilities
Service goal a moving target = delay and frustration
No formalized governance
Response to partner site & internal providers = multiple tech change
High provider/staff turnover
No pro forma & unrealistic volume expectations
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Processes to be Navigated in
Telehealth Service Development
Strategy
Procurement
Compliance
Legal
Provider
engagement
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- Created by UK in 1980’s
- Detailed practices for IT
service management
- Aligns services with business
needs
- Used worldwide:
- US Governments (States,
Navy, Army)
- Industry (Disney, Honda,
Visa)
Discovered ITIL
(Information Technology Infrastructure Library)
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“Telehealth is a clinical service delivered
over an IT service”
Provided terminology and a standard framework
Highlighted strengths & weaknesses
Adapted the Idea of ITIL to
Create the Telehealth Service
Implementation Model
(T-SIM
©
)
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Telehealth Service
Implementation Model (T-SIM
©
)
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Telehealth Service Strategy
Defines scope of the service
Condition(s)
Location of patients
Type of providers
What problem is being
solved?
Key Processes:
Strategy Management
Demand Management
Portfolio Management
Financial Services Management
Business Relationship Management
(BRM)
Value Creation
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Thinking beyond “replicating care over distance”
MUSC Mission statement: “Telehealth for efficient,
effective care
Assess the impact on stakeholders:
1) Patients
2) Referring providers
3) Consulting providers
4) Payers
5) Health system (as a whole)
Prioritize services that:
Add efficiency to care teams
Add value to care over the continuum
Mitigate time and distance barriers to care
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Telehealth Standardized Scoring Tool
Support of implementation
Physician champion
Provider capacity
Strategic alignment
Potential impact
Quality
Cost
Access to care
Growth opportunity
Market size
Saturation
Demand
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Telehealth Cardinal Sins
Setting up a telehealth program:
1. without provider engagement &
availability
2. without a clear path from patient to
technology
3. without an evaluation plan
4. untethered from organizational strategy
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Telehealth Service Design
Implement a common
architecture
Understand each “site of care”
has different rules
Draft clinical and operational
protocols
Customize test scripts
Identify KPI’s
Navigate compliance, legal,
credentialing and EHR issues
and processes
Key Processes:
Design Coordination
Availability Management
Capacity Management
Information Security
Management
Training Management (internal
staff, providers, sites)
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Design Coordination
maintain a common architecture for all activities and processes
Clinical
Protocols Workflows Test Scripts
Technology
Equipment
and Site
Assessment
Procurement Installation
Administrative
Legal
Credentialing
- Regulatory
Billing -
Compliance
Outcomes
Performance
Metrics
KPI Tracking
Outcomes
Reporting
Strategy
Define scope of the service
Condition(s)
Location of patients
Type of providers
What problem is being
solved?
Transition
Training
Equipment
Workflow
Mock
Calls
Technology Pre-
check
Dedicated Support
Go-Live
Dedicated IT and
Operational Support
Design
Meet the
needs of the
customers!
Operations
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RACI matrix…
through the common architecture
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Telehealth Service Transition
Design
Operations
33
Telehealth Service Transition
Movement from test to
go-live
Training tech and workflow
Mock calls (alpha internal
testing, beta partner site
testing)
Key Processes:
Transition Planning &
Support
Data & Knowledge
Management
Change Management
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Telehealth Service Operations
High quality, reliable services
Processes to manage
“incidents”
any unplanned event that has a
negative impact on normal
operations
Key Processes:
Incident Management
Problem Management
Access Management
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Striving for high-reliability
Preoccupation with failure
Reluctance to simplify interpretations
Sensitivity to operations
Commitment to resilience
Deference to expertise
Continual Quality Improvement
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Summation
Telehealth journey is complex
Success is achievable
Structured implementation
framework is major catalyst
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Contact:
Shawn Valenta, RRT, MHA
Administrator of Telehealth,
MUSC Health
valentas@musc.edu
Jillian Harvey, MPH, PhD
Associate Professor
MUSC Dept of Healthcare
Leadership & Management
harveyji@musc.edu
Questions
*Please complete online session evaluation
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2. Wood, J., Mulrennan, S., Hill, K., Cecins, N., Morey, S., and Jenkins, S. Telehealth clinics increase access to care for adults with
cystic fibrosis living in rural and remote Western Australia. Journal of Telemedicine and Telecare
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1298.
5. AlDossary, S., Martin-Khan, M., Bradford, N., Armfield, N. & Smith, A. (2017). The development of a telemedicine planning framework
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readiness for telehealth. Journal of Telemedicine & Telecare, 9:259-263.
8. Berg, M.(1999). Patient care information systems and healthcare work: a socialtechnical approach. Int J Med Inform, 55:87-101
9. Broens, T.H., Vollenbroek-Hutten, M.M., Hermens, H.J., van Halteren, A.T., Nieuwenhuis, L.J. et al. (2007). Determinants of
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10. Yellowlee
11. Tuckson, R.V., Edmunds, M., & Hodgkins, M.L. (2017). Telehealth. The New England Journal of Medicine. 377:16, 1585-1592.
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does not decrease spending. Health Affairs. 36(3).
13. Edmunds, Margo; Tuckson, Reed; Lewis, Joy; Atchinson, Brian; Rheuban, Karen; Fanberg, Hank; Olinger, Lois; Rosati, Robert;14.
Austein-Casnoff, Cheryl; Capistrant, Gary; and Thomas, Latoya (2017) "An Emergent Research and Policy Framework for Telehealth,"
eGEMs (Generating Evidence & Methods to improve patient outcomes): Vol. 5: Iss. 2, Article 1. 14. HRSA. National Advisory Committee
On Rural Health and Human Services (2015). Telehealth in Rural America. Policy Brief.
https://www.hrsa.gov/advisorycommittees/rural/publications/telehealthmarch2015.pdf
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References